The Employee Retirement Income Security Act (ERISA) of 1974 sets strict deadlines for employees seeking disability benefits through employer-sponsored plans. It is important to understand ERISA deadlines to protect your rights and avoid benefit claim denials.
Filing an Initial Claim
If an employee becomes disabled, they are advised to review their Plan’s Summary Plan Description (SPD) for specific deadlines, because they can vary from plan to plan. ERISA law does not specify a universal deadline for submitting initial claims. After reviewing the SPD to confirm eligibility and procedures to be followed, employees should submit claims promptly with all required medical evidence and documentation to avoid denial of their claim.
Insurer’s Initial Decision
After receiving the claim for disability, the plan administrator (usually an insurance company) must make a decision regarding the claim within 45 calendar days of receiving it. The administrator is permitted to extend this period by 30 days, but they must notify the claimant of any circumstances beyond their control that warrants an extension of the claim, with any future extensions requiring notification before the expiration of the first. It is not unusual for an administrator to request additional information, but must do so within the initial 45-day period, giving the claimant 45 days to respond with the requested information.
Denied Disability Claims
If a claim is denied, the employee has 180 days from receiving the denial notice to file an appeal. This is a critical window to gather additional evidence to strengthen your case. It is highly recommended that claimants seek the help of an experienced disability benefits denial attorney to assist them with the appeals process. Once the administrator receives an appeal, they must issue a decision within 45 days of receiving it, with a possible extension of 45 days after notification to the claimant.
Final Decision and Judicial Review
If the appeal for employee disability benefits is denied the plan must provide a written explanation to the claimant regarding their decision. If the plan permits, the claimant may be able to file a second appeal including any additional information to strengthen their claim. If a second appeal is not possible, the claimant may file a lawsuit under ERISA, where the court will review the case and evidence contained therein. The statute of limitations for ERISA lawsuits varies so it is crucial to check the plan terms or state law and consult an ERISA attorney to preserve legal options.
Contact an ERISA Denied Disability Benefits Lawyer for Help
When you have been denied disability benefits, it is important to seek the help of an experienced disability attorney to file an appeal or litigate your case in court. Contact the disability denial attorneys of Alan C. Olson & Associates at 262-785-9606.
